Intrajejunal feeding of liquid formula diets has been used in nutritional support for the past 50 years. Feeding delivered directly into the small intestine can take advantage of both the gastroesophageal and pyloric sphincters in preventing regurgitation. This technique is attractive because it may be used for both temporary and long-term feeding whenever small bowel motility and absorptive capacity are adequate. It may be used in spite of disease states and conditions which may alter gastric, biliary, and/or pancreatic function.
Intrajejunal feeding is indicated in cases of carcinoma of the esophagus, carcinoma of the stomach, radiation esophagitis, head and neck carcinomas, mechanical and motility disorder/dysphagia, esophageal stricture, gastric motility disorders, neuromuscular disorders and post surgical feeding.
Jejunostomy techniques of historical and practical interest include, for example, the techniques of Surmay, Maydl, Stamm and Witzel. Surmay's technique was a failure because of leakage of jejunal contents. The Witzel and Stamm jejunostomies are still in use, but are fraught with problems of leakage around the jejunostomy tube into the peritoneal cavity or onto the skin, bowel obstruction from the tube or from internal hernia, and the persistence of enterocutaneous fistula after the large tube is removed. The Maydl jejunostomy avoides these problems by use of the roux-en-y and affords permanence. It is more complicated and technically demanding. The use of the Maydl jejunostomy was more frequent in the early 1950s. The needle catheter jejunostomy (NCJ) is a modification of the Witzel jejunostomy evolved from the concept of using a fine catheter for intrajejunal feeding and from the availability of a variety of relatively low viscosity, complete liquid formula diets. The major problems with the (NCJ) are blocked, kinked and pulled catheters. The problems with jejunostomy techniques and equipment have limited the use of this technique. Current studies in nutritional support keep providing evidence of benefits of feeding this area of the bowel.
Standard feeding systems provide high rates of feeding in the range of 800 to 1200 ml. per hour. These rates are adjusted with a clamp or pump in normal patient feeding. In jejunal feeding high rates are not desirable and the standard feeding equipment is not advantageously employed.